By Sola Ogundipe and Chioma Obinna
Dark clouds gathered over Nigeria weekend as the cold hands of death snatched away wife of former Military Head of State, Mrs Maryam Babangida after a prolonged battle against cancer of the ovary.
Reports indicated the late Maryam had battled the disease for months at the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, where she eventually succumbed to it. Ovarian cysts which have a 1 per cent incidence rate in Nigerian women is a major causative factor of ovarian cancer, believed to be the second most common cancer in the country.
In a reaction, renowned gynaecologist and joint pioneer of In vitro Fertilisation (IVF) in Nigeria Prof. Oladapo Ashiru, said the spate of cancers in the country may not be unconnected with the rising profile of the pollution of the environment. â€œWhen we look at the incidence of cancers in the country, it can be attributed to environmental pollution. Everything is polluted, The food we eat and water we drink are not sanitised. We are ingesting poisons and the environmental protection agency is not doing anything to safeguard lives here.â€
Ashiru who is also Medical Director, Medical ART Center, Lagos noted that there are no studies or research to determine the effects of the pollutants in the atmosphere in the country.Â â€œWhat government needs to do urgently is to begin to take critical stock of environmental safety for the sake of the health of the people.
Regretting the passage of the former First Lady, he urged Nigerian adults to go for constant and comprehensive medical evaluation once they attain the age of 40.
â€œ The idea is that as soon as you attain the age of 40, you should go for a comprehensive medical examination. As from 50 and above, women should be undergoing procedures like a mammogram, ultrasound scan and blood evaluation.
Consultant Gynaecologist, Dr. Boniface Oye-Adeniran of the Lagos University Teaching Hospital (LUTH) Idi_Araba Lagos noted that available statistics of ovarian cysts amongst Nigerian women may not capture the actual number of patients because many do not go to hospital for treatment.
â€œWhile ovarian cysts are not often cancerous, they do develop into cancerous tumours. The cause of ovarian cysts is not known and ovarian cysts often occur when hormonal changes distort the functioning of the ovaries leading to formation of cysts around the ovaries. They often lead to mild to severe pains around the pelvis region.â€
Associate professor and Consultant Obstetrician & Gynecologist at the Oncology & Pathological Studies Unit, College of Medicine (CMUL), Lagos University Teaching Hospital (LUTH),Â Dr. Rose Anorlu describes ovarian cancer as â€œone cancer that is very difficult to prevent all over the world.â€
Anorlu said though there is no data on the prevalence of ovarian cancer in Nigeria, at LUTH, it is the second most common cause of death in gynecological death, LUTH being a referral centre. .â€œIt is a very deadly cancer with very low survival rate because by the time it is diagnosed, it would have spread to other organs of the body.â€
She noted that it affects women of all ages but it is most common in women between the ages of 50 to 70 years and above. Very few of the women who are diagnosed of it live for over five years after. â€œMost die in the first two years of diagnosis.â€
Although, ovarian cancer very difficult to prevent, women with abdominal pain, bloated tummy, feeling of fullness after only eating a littleÂ and those with deep_seated pain in the tummy to seek prompt medical attention. â€œDonâ€™t wait until they have symptoms before going for routine checks yearly for breast cancer, cervical cancer including pap smear and ultrasound scan. Post- menopausal women in particular should go for routine self_breast examination,, a mammogram test and a pelvic ultrasound scan to check the ovaries.
â€œYou can screen about 1,000 women and get only one person with ovarian cancer. The main risk factor for ovarian cancer is for a womanÂ not to have had a baby at all. Having many children protects women from having ovarian cancer. Similarly, oral contraceptive also protects women from this condition. However, it should be noted that while oral contraceptive protects women from ovarian cancer, it puts women at risk ofÂ breast and cervical cancer. Prevention of ovarian cancer is difficult, unlike cervical cancer that has a pre_cancer stage, ovarian cancer does not.â€ she argued.
However, the Federal Ministry of Health is already doing something to check the incidence of the increasing incidence of cancer in the country.Â Already, a cancer palliative care mechanism is in the making at all Federal Teaching hospitals across the Federation. Dr Patience Osinubi, Coordinator of the Cancer Control Programme of the Federal Ministry of Health told VanguardÂ that it was true that the incidence of cancer is on the increase, but that government is rising to the challenge.
â€œWe are seeing all types of cancers that we have not been seeing in the past. Truly, the incidence of cancer is on the high side now, we are seeing more and treating more types of cancers. But what we are doing is encouraging holistic approach to treating andÂ management of the patient. Government is also trying to improve the referral system and there is a directive from the Minister of Health that as from the first quarter of next year, all the 55 teaching hospitals nationwide must begin to offer cancer screening services.
Noting that presently, there is no central cancer registry in Nigeria, Osinubi said government has set up the cancer control programme so the Federal Ministry of Health set up the cancer unit to ensure that by the end of the year there would be proper data. â€œAll the teaching hospitals will begin palliative care. We want to do a lot of psychological, religious and emotional counselling about overcoming the anxiety of cancer. We also intend to train more doctors and nurses.â€
Further, she revealed that as from the first quarter of 2010, a pilot scheme of free cervical cancer vaccination of young Nigerian girls with gardasil and cervarix vaccines is set to commence with in six States in the country. â€œWe are also looking into the area of research to see if any of our local herbs have anti-cancer properties. There is a five-yr cancer-control plan with 10 goals in the plan. Government is encouraging a holistic approach to cancer management. We are looking at palliative care because cancer is a disease of pain, andÂ control is paramount in this light. There is a plan to collect morphine powder from our laboratories in Oshodi and begin to make morphine syrup for patients at low cost. Cancer is also an expensive disease, but there Nigeria is collaborating with the International Atomic Energy Agency (IAEA) in an eight-year partnership that government has committed about N 37.7 million as counterpart funding.
Osinubi said at the end of the eight years, 10 teaching hospitals in the country are expected to have cancer radiotherapy centers that are amongst the best in the world. management with nuclear medicine which is the way forward for cancer management globally.
â€œWe are also collaborating with the First Lady, Hajiya Turai Yarâ€™Adua. Her Cancer Center in Abuja isÂ providing funds while we are providing technical support. She is supporting cancer management in the country and recently donated cancer treatment drugs to the National Hospital, Abuja, the University of Port Harcourt Teaching Hospital, the University of Nigeria Teaching Hospital, the University College Hospital, Ibadan, and Ahmadu Bello University Teaching Hospital, Zaria. Each center obtained drugs valued at $400 to be given free to indigent cancer patients.â€
In a study carried out by the Ovarian Cancer Service, Gynaecological Oncology Unit, Departments of Obstetrics and Gynaecology and Surgery, College of Medicine, University College Hospital, Ibadan, by Odukogbe, Adebamowo and others on â€œOvarian Cancer in Ibadan: Characteristics and Management, it was reported that â€œOvarian cancer has the highest case fatality rate among gynaecological cancers worldwide because of lack of effective screening methods and non_specific early warning symptoms with late presentation. The study noted that the decreasing fertility rate and increasing use of ovulation induction drugs are some of the reasons.
The Ovarian Cancer Service of the Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Oyo State, Nigeria commenced the first longitudinal study of this malignancy from December 1st, 1998 in order to establish a regional management and research centre and found it to be the third most common of the gynaecological cancers, representing 9.8 per cent of the 214 cases.
More than 60 per cent of the patients were 50 years or younger. In their report, the researchers noted: â€œOnly 19 per cent were nulliparous, with 47.6 percent having had five or more deliveries. Only two patients (9.5 percent) had used the oral contraceptive pill, for a maximum period of 1 month. Only one patient (4.8 per cent) had a positive family history of cancer.â€
Abdominal swelling was the most common presenting symptom.81 per cent of the patients presented in Stages III and IV. Epithelial ovarian cancer constituted about 76.2 percent of the cases. Only 23.8 per cent had adjuvant therapy, consisting of combination chemotherapy using cisplatin-based regimes.
The case fatality rate six months after surgery was 76 per cent. Their conclusion was that ovarian cancer patients in this environment are younger and of higher parity than expected with recommendation that the risk factors required further study.
Ovarian Cancer At A Glance
*Most ovarian growths in women under age 30 are benign, fluid_filled cysts.
*There are several types of ovarian cancer.
*Factors that increase the chance of developing ovarian cancer have been identified.
*The symptoms of ovarian cancer can be vague.
*Detection of ovarian cancer involves physical examination (including pelvic exam), ultrasound, X_rays, the CA_125 blood test and biopsy of the ovary.
*The treatment of ovarian cancer depends on the stage of the disease and the age and health of the woman.